Healthcare Provider Details

I. General information

NPI: 1457516775
Provider Name (Legal Business Name): CRISTY L. COX RUSSO PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CRISTY L AKINS PHD

II. Dates (important events)

Enumeration Date: 07/25/2008
Last Update Date: 07/23/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13535 NEMOURS PKWY
ORLANDO FL
32827-7402
US

IV. Provider business mailing address

PO BOX 191
ROCKLAND DE
19732-0191
US

V. Phone/Fax

Practice location:
  • Phone: 904-567-4000
  • Fax:
Mailing address:
  • Phone: 302-651-6212
  • Fax: 302-651-4945

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License Number1067
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License Number9153
License Number StateMA
# 3
Primary TaxonomyY
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License NumberPY8775
License Number StateFL
# 4
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number1067
License Number StateLA
# 5
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number9153
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: